Liz Truss: friend or foe? …The jury is out
Authors: None The Lancet Public Health
Journal: The Lancet Public Health (2022)

On Sept 5, with 80 000 votes, Liz Truss won the Conservative Party leadership and was appointed UK Prime Minister. In her first week in office, Truss outlined her priorities—the economy, the energy crisis, and the National Health Service (NHS), and nominated a close ally, Therese Coffey, her deputy and health secretary. Will the duet and their newly formed government address the predicaments faced by British people? The UK is enduring a particular grim time, mourning Queen Elizabeth II, while facing a long recession and inflation hitting double digits. Her first 100 days in office will be crucial to set out the direction. Here is why focusing on public health and its wider determinants should be the new government's priorities.First, the government needs to protect and strengthen the health-care system. The NHS workforce is exhausted and demoralised, and currently facing a staffing shortage as high as one in ten positions being vacant in England. Such shortages impact patient care and safety. There are currently 6·7 million people waiting for hospital treatment and unacceptable delays in accident and emergency departments admission, as high as 12 h. There is an unequivocal need to train and retain nurses. There is also a clear need to invest in social care. But this should not come at the expense of the NHS. Shifting the £13 billion health-care spending earmarked for the NHS to social care will be short-sighted. The government will need to rapidly come up with a plan to finance social care without stripping the already fragile NHS.Second, the government needs to address the cost-of-living crisis and the socioeconomic determinants of health more broadly. It is crucial to act on the immediate crisis but it is equally important to reduce health inequalities in the longer term. The energy crisis is more than a fuel bill crisis, it is a public health crisis in the making that threatens to escalate into an avoidable health emergency that will widen inequality and shorten lives. The report Fuel poverty, cold homes and health inequalities in the UK published on Sept 1, by the UCL Institute of Health Equity lays out how cold and poverty worsen health and increase health inequalities. Families having to live in cold homes also endure poor indoor air quality, damp, and mould. Cold homes are associated with an increased risk of respiratory and cardiovascular diseases, poor mental health, and injury. Treating illnesses linked to cold, damp, and unsafe homes has been estimated to cost the NHS £2·5 billion per year. Children, older people, and those with pre-existing health conditions are at greatest risk. It is estimated that one in five UK households with children experienced fuel poverty in 2020. Fuel poverty and cold homes can also affect children's education: UK children miss more school days due to diseases associated with damp than other European countries, according to the report.Lifelong health inequalities take root in childhood—supporting the most vulnerable to reduce socioeconomic stresses and shocks should be prioritised, for British citizens and refugees alike. Indeed, the study by Line Bager and colleagues, published in this issue of The Lancet Public Health, examined the experience of adversity (including poverty) in children of parents who are migrants to a high-income country. The study highlights how issues such as the intergenerational transmission of trauma and socioeconomic conditions are interconnected. For these children, the burden of adversity and stress can be profound and should have implications for policy. Schools are an important place to support children, to identify and address vulnerabilities, and to invest in their health and future. Education is a powerful determinant of wellbeing—as such, it should be a key pillar of the government's investments plans.The effects of poverty and adverse childhood experiences on health are increasingly documented and their associated poor health outcomes in adulthood should be a source of concern for the new UK Government. Their choices and policies will have long lasting consequences. The first 100 days of the Truss Government must set an ambitious agenda for public health focusing on strengthening the health-care and social care systems in parallel, not antagonistically, on tackling poverty, addressing childhood adversity, and investing in children's futures. On Sept 5, with 80 000 votes, Liz Truss won the Conservative Party leadership and was appointed UK Prime Minister. In her first week in office, Truss outlined her priorities—the economy, the energy crisis, and the National Health Service (NHS), and nominated a close ally, Therese Coffey, her deputy and health secretary. Will the duet and their newly formed government address the predicaments faced by British people? The UK is enduring a particular grim time, mourning Queen Elizabeth II, while facing a long recession and inflation hitting double digits. Her first 100 days in office will be crucial to set out the direction. Here is why focusing on public health and its wider determinants should be the new government's priorities. First, the government needs to protect and strengthen the health-care system. The NHS workforce is exhausted and demoralised, and currently facing a staffing shortage as high as one in ten positions being vacant in England. Such shortages impact patient care and safety. There are currently 6·7 million people waiting for hospital treatment and unacceptable delays in accident and emergency departments admission, as high as 12 h. There is an unequivocal need to train and retain nurses. There is also a clear need to invest in social care. But this should not come at the expense of the NHS. Shifting the £13 billion health-care spending earmarked for the NHS to social care will be short-sighted. The government will need to rapidly come up with a plan to finance social care without stripping the already fragile NHS. Second, the government needs to address the cost-of-living crisis and the socioeconomic determinants of health more broadly. It is crucial to act on the immediate crisis but it is equally important to reduce health inequalities in the longer term. The energy crisis is more than a fuel bill crisis, it is a public health crisis in the making that threatens to escalate into an avoidable health emergency that will widen inequality and shorten lives. The report Fuel poverty, cold homes and health inequalities in the UK published on Sept 1, by the UCL Institute of Health Equity lays out how cold and poverty worsen health and increase health inequalities. Families having to live in cold homes also endure poor indoor air quality, damp, and mould. Cold homes are associated with an increased risk of respiratory and cardiovascular diseases, poor mental health, and injury. Treating illnesses linked to cold, damp, and unsafe homes has been estimated to cost the NHS £2·5 billion per year. Children, older people, and those with pre-existing health conditions are at greatest risk. It is estimated that one in five UK households with children experienced fuel poverty in 2020. Fuel poverty and cold homes can also affect children's education: UK children miss more school days due to diseases associated with damp than other European countries, according to the report. Lifelong health inequalities take root in childhood—supporting the most vulnerable to reduce socioeconomic stresses and shocks should be prioritised, for British citizens and refugees alike. Indeed, the study by Line Bager and colleagues, published in this issue of The Lancet Public Health, examined the experience of adversity (including poverty) in children of parents who are migrants to a high-income country. The study highlights how issues such as the intergenerational transmission of trauma and socioeconomic conditions are interconnected. For these children, the burden of adversity and stress can be profound and should have implications for policy. Schools are an important place to support children, to identify and address vulnerabilities, and to invest in their health and future. Education is a powerful determinant of wellbeing—as such, it should be a key pillar of the government's investments plans. The effects of poverty and adverse childhood experiences on health are increasingly documented and their associated poor health outcomes in adulthood should be a source of concern for the new UK Government. Their choices and policies will have long lasting consequences. The first 100 days of the Truss Government must set an ambitious agenda for public health focusing on strengthening the health-care and social care systems in parallel, not antagonistically, on tackling poverty, addressing childhood adversity, and investing in children's futures. Adverse childhood experiences among children of parents who are refugees affected by trauma in Denmark: a register-based cohort studyOur findings suggest that children with parents from refugee-sending countries have a higher rate of several ACEs compared with the general population. Furthermore, having a parent who is a refugee affected by trauma and seeking treatment seems to be an independent risk factor for poorer health and adjustment in adulthood. This study informs decision makers and caregivers that there might be much added value in addressing needs within the whole family, as opposed to only attending to the parent who is seeking treatment. Full-Text PDF Open Access